infant mortality; prenatal care; patient-centered care; social determinants of health; discrimination; health disparities


Maternal and Child Health | Obstetrics and Gynecology | Public Health | Social Work


Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities.

Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as non-white.

Results: Even when care was perceived as strong quality, participants perceived a lack of patient-centeredness. Participants knew the importance of prenatal care and actively prioritized it even when experiencing challenges accessing healthcare services or barriers to broader conditions needed to be healthy. Participants also reported experiencing discrimination in healthcare.

Conclusions & Implications: The women esteemed providers’ clinical advice, but felt unheard in their prenatal care experiences and faced structural challenges which may be addressed by changing institutional policies and procedures.